Navigation Links
Obese patients face increased risks for infection and dislocation following revision hip surgery
Date:5/8/2008

Along with age and injuries, obesity is a leading risk factor for osteoarthritis (OA), a painful and disabling joint disease. While excessive weight can aggravate the toll on almost any joint, obesity has been associated with a higher prevalence of hip OA and an increase in total hip arthroplasty (THA). Whether obese hip OA patients are more prone to postsurgical complications, however, remains open to debate and investigation, since the results of existing studies conflict. Whats more, only a few short-term studies have focused on how obesity affects the outcomes of revision THA. Compared to primary THA revision surgery is a longer and more complicated procedure implying more extensive tissue damage and a greater risk of prosthetic joint infections and dislocations, as well as other long-term complications.

Researchers at Geneva University Hospitals set out to evaluate the impact of obesity on the incidence of serious complications after revision THA, over a period of up to 5 years. The team also aimed to determine whether functional improvement, pain, and satisfaction 5 years after the second hip replacement differed between obese patients and patients of healthy weight. Their results, presented in the May 2008 issue of Arthritis Care & Research (www.interscience.wiley.com/journal/arthritis), reveal a strong correlation between obesity and high rates of adverse events, as well as lower functional gains and more persistent pain, after revision THA.

This long-term study focused on all patients who underwent a revision THA, excluding re-revisions, at the universitys hospitalthe only public hospital serving the urban and suburban populations of Geneva, Switzerlandbetween 1966 and 2006. Of the 204 subjects, 114 were women and 90 were men, with a mean age of 71.6 years. Based on height and weight data obtained just before surgery, 52 patients, 25 percent of the sample, were defined as obese, with a body mass index (BMI) of 30 or more. The standard range for a normal BMI, the ideal weight to height ratio, is between 18 and 25. To further assess the association between BMI and postoperative outcomes, patients were also examined in 4 BMI categories: less than 25; 25 to 29.9, defined as overweight; 30 to 34.9; and 35 or more.

Based on patient records and follow-up examinations, the researchers first documented the occurrence of one or more adverse events within 5 years after the first revision THA: surgical site infection, dislocation of the prosthetic hip, or re-revision surgery for any cause. They then relied on trusted, hip-specific clinical evaluations, including the Harris Hip Score (HHS), along with in-person and phone interviews with patients, to measure each subjects functional status, level of pain, and general satisfaction with the procedure 5 years later. Finally, researchers used statistical analyses, including incidence rates and hazard ratios, to compare the outcomes between obese and non-obese patients after revision THA.

Overall, 20 complications occurred in 17 (33 percent) of the 52 obese patients, compared with 18 events in 13 (9 percent) of the 152 non-obese patients. In terms of specific complications, the incident rate was 4 times higher for surgical site infection and 3.5 times higher for dislocation. Even more striking, the incidence rate for occurrence of one or more adverse events rose with rising BMI. This increase was small between normal and overweight patients1.5 times higher. Yet, it became significantly greater in the group with a BMI between 30 and 34.94.5 times higher than normal weight patients. And it escalated to an alarmingly increase in the group with a BMI of 35 or more10.9 times higher. In these calculations, adjustments were performed for age, sex, and preoperative health status.

For those patients scheduled for a 5 year follow-up visit, 83 percent of the obese patients and 85 percent of the non-obese patients were available for evaluation. In general, the obese patients had moderately lower functional improvements and higher levels of routine hip pain. However, patient satisfaction with the result of their revision THA was gauged to be about the same in both groups.

As its lead author, Dr. Anne Lbbeke, acknowledges, this study is limited by the relatively small number of adverse events resulting in large confidence intervals and restricting the adjustment for baseline differences between obese and non-obese patients to the most important confounding factors. Despite such weaknesses, the findings reinforce revision THA as a technically-challenging intervention, particularly when performed on obese patients.

Surgeons, patients, and referring physicians should be aware of an increased risk in this patient group, Dr. Lbbeke stresses. Further studies are necessary to evaluate whether changes in medical preparation, surgical technique, and implant choice can help reduce the adverse event rate in obese patients undergoing revision THA.


'/>"/>

Contact: Sean Wagner
swagner@wiley.com
781-388-8550
Wiley-Blackwell
Source:Eurekalert

Related medicine news :

1. How to manage Chinese obese children with non-alcoholic fatty liver disease?
2. Aspirin-like compounds increase insulin secretion in otherwise healthy obese people
3. Obese women disadvantaged in both breast cancer treatment and diagnosis
4. Obese Women Less Likely to Be Tested for Some Cancers
5. Overweight, Obese Women Improve Quality of Life With 10 to 30 Minutes of Exercise
6. Breast cancer more aggressive among obese women
7. Obese Children Face More Complications During Surgery
8. Overweight and obese men have lower PSA values, even before they get prostate cancer
9. Born to Be Obese?
10. Bone mineral content continues to increase in obese adolescents during weight loss
11. Anti-Inflammatory Drug Improves Glycemia, Lowers Inflammation in Obese, Young Adults
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/25/2016)... , ... June 25, 2016 , ... On Friday, June ... a Bronze Wellness at Work award to iHire in recognition of their exemplary accomplishments ... of the 7th annual Maryland Workplace Health & Wellness Symposium at the BWI Marriott ...
(Date:6/24/2016)... ... 24, 2016 , ... June 19, 2016 is World Sickle Cell Observance Day. ... the benefits of holistic treatments, Serenity Recovery Center of Marne, Michigan, has ... , Sickle Cell Disease (SCD) is a disorder of the red blood cells, which ...
(Date:6/24/2016)... ... June 24, 2016 , ... ... for accelerated orthodontic treatment. Dr. Cheng has extensive experience with all areas of ... AcceleDent, and accelerated osteogenic orthodontics. , Micro-osteoperforation is a revolutionary adjunct to ...
(Date:6/24/2016)... , ... June 24, 2016 , ... ... at the Clinical Decision Making in Emergency Medicine conference in Ponte Vedra Beach, ... journal articles published in Emergency Medicine Practice and Pediatric Emergency Medicine ...
(Date:6/24/2016)... ... ... National recruitment firm Slone Partners is pleased to announce the ... as Vice President of North American Capital Sales at HTG Molecular . ... team in the commercialization of the HTG EdgeSeq system and associated reagents in North ...
Breaking Medicine News(10 mins):
(Date:6/24/2016)... , Belgium , June 24, ... VNRX), today announced the appointment of Dr. ... Directors as a Non-Executive Director, effective June 23, ... Audit, Compensation and Nominations and Governance Committees.  As ... Futcher will provide independent expertise and strategic counsel ...
(Date:6/23/2016)... 23, 2016 Any dentist who has made an ... current process. Many of them do not even offer this ... and high laboratory costs involved. And those who ARE able ... such a high cost that the majority of today,s patients ... Parsa Zadeh , founder of Dental Evolutions Inc. and ...
(Date:6/23/2016)... , June 23, 2016 Research and ... Devices Medical Market Analysis 2016 - Forecast to 2022" ... The report contains up to date financial data derived ... Assessment of major trends with potential impact on the market ... of market segmentation which comprises of sub markets, regional and ...
Breaking Medicine Technology: